Molina Healthcare of Texas Prior Authorization

Effective March 15, 2026, Molina Healthcare of Texas will require prior authorization for Mental Health Rehabilitative Services - Skills Training & Development and Psychosocial Rehabilitative Services (Adults).

Yesenia Rios
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Molina

Eligibility Process

### Confirm the member’s Molina plan and eligibility Before you start, verify: - the member is active with **Molina Texas Medicaid/CHIP** - the member ID is correct - the service date range is current - your provider/NPI/TIN are correct

Prior Authorizations Requirements

H2014 (Skills Training) - **Requires Prior Authorization** T1017 (Routine & Intensive Case Management)- **Prior Authorization Not Required** H0034 (Medication Training & Support) - **Prior Authorization Not Required** H2017 (Psychosocial Rehabilitative Services for Adults with LOC-3 and LOC-4) - **Requires Prior Authorization** H2011 (Crisis Intervention) - **Prior Authorization Not Required**

Please follow the example provided for Molina Prior Authorization:

Molina Prior Authorization Form for Clinics

***Here is a blank copy of the Molina Prior Authorization Form:*** [Texas Standard Prior Authorization Request Form for Health Care Services](https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/tx/medicaid/forms/Tx-Standard-Prior-Authorization-Request-Form-for-HCS_changes_LTSS_R.ashx)

Please submit Molina Prior Authorizations via fax only and ensure that telephone/fax number is the following on all Prior Authorizations: Corporate Phone: 1-888-988-6329 \ Corporate Fax: 936-417-8015

Allocation of Units

The Allocation of Units Charts are based on official guidance from the Texas Resilience and Recovery (TRR) Utilization Management guidelines, published by the Texas Health and Human Services Commission. - Texas Resilience and Recovery Utilization Management Guidelines:\ **Child and Adolescent Services** - Range: 72 units to 144 units - Utilized for Services - Skills Training & Development (H2014) - Texas Resilience and Recovery Utilization Management Guidelines:\ **Adult Mental Services** - Utilized for Services - Skills Training & Development (H2014) - Range: 24 units to 84 units - Must be authorized for LOC-1S and LOC-2 - Psychosocial Rehabilitative Services (H2017) - Range: 84 units to 342 units - Must be authorized for LOC-3 and LOC-4

Skills Training (H2014) Unit Allocation Table - Children & Adolescents

Allocation of Units for Children and Adolescent Mental Health Services

## Clinical Interpretation (For Documentation & PA Use) ### **[[LOC-2 (Low–Moderate Need)]]** - Early-stage or stabilized youth - Needs **skill reinforcement**, not intensive intervention - Focus: - coping skills - behavior management - routine development *\*\*\*Use when deficits are present but not severe or pervasive\*\*\** ### Justification Language for LOC-2 **The client demonstrates mild to moderate impairment and requires structured Skills Training to improve coping, behavior management, and daily functioning.**

## Clinical Interpretation (For Documentation & PA Use) ### **[[LOC-3 (Moderate Need)]]** - Youth with **ongoing behavioral/emotional challenges** - Needs **consistent skills training and support across settings** - Focus: - emotional regulation - social skills - school functioning *\*\*\*Most common level for ongoing MHR services\*\*\** ### Justification Language for LOC-3 ### The client presents with moderate functional impairment requiring consistent rehabilitative intervention to improve emotional regulation, social functioning, and stability across settings.

## Clinical Interpretation (For Documentation & PA Use) ### **[[LOC-4 (Moderate–High Need)]]** - Youth with **significant impairment across multiple domains** - May include: - aggression - placement instability - repeated school issues - Needs **frequent intervention and structured support** *\*\*\*Strong justification needed for higher units\*\*\** ### Justification Language for LOC-4 **The client demonstrates significant impairment across multiple domains and requires frequent, structured intervention to develop and maintain functional skills necessary for stability.**

Clinical Justification Guide

Weekly Allocation (90 day Authorization Period)

Skills Training (H2014) Unit Allocation Table - Adults

Allocation of Units for H2014 (Skills Training) Adult Mental Health Services

Clinical Justification Guide for H2014 (Skills Training) - Adults

Weekly Scheduling Breakdown for H2014 (Skills Training) - Adults

H2017 - Psychosocial Rehabilitative Services

Psychosocial Rehabilitative Services (PRS) are rehabilitative, skill-based interventions provided to adults with serious mental illness to restore and improve functional abilities necessary for independent living and community integration. Approved Level of Care (LOC-3 and LOC-4) — Adults (Texas TRR) PRS is authorized for adults who meet criteria and services must align with authorized LOC-3 or LOC-4.

Allocation of Units (H2017 - Psychosocial Rehabilitative Services) Adult Mental Health Services

Prior Authorization Supporting Documentation

**Attach Supporting Documentation Required for Molina Prior Authorization:** 1. Molina Prior Authorization Form 2. Biopsychosocial Assessment 3. Initial CANS/ANSA Assessment & Update CANS/ANSA Assessment 4. Initial Treatment Plan & Update Treatment Plan

**Disclaimer:** Submission of a prior authorization request and the requested number of units does not guarantee approval by the Managed Care Organization (MCO), Molina Healthcare. All requests are subject to clinical review, medical necessity determination, and applicable state and payer guidelines. Approved services, units, and authorization periods may differ from those requested.

**Corporate will receive all authorization correspondence and will forward any incoming approved, denied, or general correspondence as it is received. Please feel free to reach out to the Administrative Department if you have not received an approval within 7 business days.**

### Save the approval details before services begin Once approved, save: - Authorization Number - Approved Service Code(s) - Approved Authorization Dates - Approved Units

Molina Prior Authorization Checklists

Molina Prior Authorization Checklist (H2017)

Please send any questions related to Molina Prior Authorizations to Clinical Director: yesenia@texascarecenter.com.